Female residents more often experienced pregnancy and parenthood-based mistreatment than their male counterparts.
This is according to a survey-based study of US surgical residents that unearthed evidence to suggest clinical training comes with measurable risks for women.
They were also more likely to suffer from obstetric complications and postpartum depression compared to the partners of male residents.
Additionally, mistreatment of residents and postpartum depression, whether experienced by female residents or the partners of male residents, were associated with resident burnout and thoughts of leaving the profession.
The authors say the data are a ‘compelling call to action for our profession’ and that research must go beyond ‘talking about the challenges’ to finding solutions.
The investigators from Massachusetts General Hospital, a founding member of the Mass General Brigham healthcare system, surveyed more than 80% of all surgical residents in the US.
The mistreatment was associated with burnout, thoughts of leaving the profession and thoughts of suicide.
The study is the most comprehensive assessment of the experience of pregnancy and parenthood in any specialty training program to date.
Although many training programs have achieved gender parity, gender disparities related to the experience of parenthood during general surgery residency persist, according to senior author Erika Rangel, an acute care and gastrointestinal surgeon and the Associate Program Director for the General Surgery residency at Massachusetts General Hospital.
She said: ‘This study highlights the magnitude of parental discrimination and adverse maternal health outcomes in surgical training, providing evidence that pregnancy during clinical training involves measurable risks. Consequently, improving support is essential for advancing gender equity.’
For the study, 5,692 residents from 325 US general surgery programs provided survey responses, with 957 residents (16.8%) reporting a pregnancy (for themselves or their partner) during clinical training (22.3% male and 10.2% female). Responses revealed that, compared with male residents, female residents were more likely to delay having children due to training (46.8% vs. 32.8%) and experience pregnancy/parenthood-based mistreatment (58.1% vs 30.5%).
Female residents had 42% higher odds of experiencing obstetric complications and 63% higher odds of developing postpartum depression compared with male residents’ partners.
Pregnancy/parenthood-based mistreatment was linked with 2.0 times higher odds of experiencing burnout and 2.5 times higher odds of having thoughts about leaving the profession.
Postpartum depression – whether in female residents or male residents’ partners—was linked with 1.9 times higher odds of burnout, 2.3 times higher odds of thoughts of leaving the profession, and 5.6 times higher odds of thoughts of suicide.
Erika Rangel said: ‘These data are a compelling call to action for our profession. In the American College of Surgeons Board of Governors, I co-chair a workgroup focusing on pregnancy complications and infertility in surgeons. To safeguard maternal-foetal health, we developed recommendations for restricting 24-hour and overnight calls for surgeons during the third trimester.’
The statement was issued by the American College of Surgeons in mid-May and has been endorsed by the American Board of Surgery, American Board of Colon and Rectal Surgery, American Board of Neurological Surgery, American Board of Oral and Maxillofacial Surgery, American Board of Plastic Surgery, and American Board of Thoracic Surgery.
Rangel noted that the next steps include pushing for national advocacy for maternal health support across all specialities, for trainees and practising physicians and surgeons and extending research beyond ‘talking about the challenges’ to finding solutions.
The findings are published in JAMA Surgery.
